Dementia care today has a higher profile, helped by the government’s dementia strategy and driven by the enthusiasm of clinicians to seize the moment and make a difference. Nigel Hawkes presents the shortlisted teams

Memory cafe

At North Bristol NHS Trust a memory cafe has been established as a meeting point for carers. For two hours once a week they can share homemade cakes and tea and coffee with others in the same situation, often bringing the patients they look after along with them. Memory cafes are usually community assets, run by the Alzheimer’s Society, but to place one in an acute hospital is new and the society needed to be convinced it was a good idea.

Judy Haworth, specialty doctor in dementia care, says: “Both patients and carers need information and on the ward it’s often difficult to provide it. Junior staff don’t know what’s available. The cafe fills this need. While it’s true that an acute trust’s patients tend to be transient, it’s equally true that they’re often at a point of decision, an emotionally charged moment which makes information even more important. If carers are looking for a home for the person they care for, say, they can find out what they should be looking for.”

The cost is modest, the feedback good, and Haworth has been gratified that members of the hospital staff who are also in their spare time dementia carers are regular attenders. In a large hospital a small dementia team has been able to make a real difference for carers and for people with dementia, she says.

Dementia first aid course

Similar motivations inspired the team at Hertfordshire Partnership University NHS Foundation Trust, where a dementia course was established for family carers, particularly those faced with challenging behaviour from those they care for. Arun Jha, consultant old age psychiatrist at the trust, says that, in the past, clinicians have seldom been involved in helping carers and it was a gap that needed filling.

The answer was a “dementia first aid” course aimed at providing basic knowledge to carers, initially 12 hours over two days but reduced to one four-hour session plus web-based support after feedback from participants. The course includes training in mindfulness, retained in the reduced format because people enjoy it and it helps them deal with stress. “They discover that they’re not alone, and that different people cope differently with problems, so they learn from one another,” Jha says.

“We are doing a long term study to see if training family carers reduces or delays hospital admissions. If carers are trained and know what to do, it would have that effect.”

Dementia challenge project

The prime minister’s “dementia challenge” has a direct impact on a project in Surrey designed to identify patients with dementia, providing a grant of £250 000 to make it possible. Sen Kallumpuram, consultant psychiatrist at Surrey and Borders Partnership NHS Trust, explains. “Diagnosis rates in the Surrey Downs area were low. We did a search through the electronic records of 33 general practices, looking for patients diagnosed with cognitive impairment, Parkinson’s disease, heart diseases, diabetes, stroke, or transient ischaemic attack. We sent letters to 6500 patients and just under 2000 came for preliminary examination. Of these, 500 had a positive screening test, and half agreed after discussion to a referral to secondary services for more detailed tests. Of those who completed the tests, 85% were found to have cognitive impairment.”

The results show, he says, that screening of at risk people, using GP records, has the potential to increase diagnosis rates. “The project was a success in promoting early and timely intervention in dementia.”

Intermediate care service for dementia

Keeping patients with dementia out of hospital and in their own homes or care homes was the focus of the shortlisted project at Dorset Healthcare University Foundation Trust. Claire Simpson, consultant psychiatrist, says that patients often had to be admitted if they were acutely unwell, though a review in 2012 showed that 38% of inpatients could potentially have been treated at home. This was made possible by creating a “virtual ward” into which they could be notionally admitted, and sending out to treat them the same care team that would have cared for them as inpatients.

“Since we began, two thirds of patients have stayed where they want to be,” she says. “Patient and carer satisfaction has improved, and costs have been reduced.” The saving is considerable, around £500 000 a year.

Torbay & South Devon Dementia Care Home Learning Community

Raising the quality of care in residential homes is demanding, admits David Somerfield of Devon Partnership NHS Trust. A TV documentary by business expert Gerry Robinson in 2009 had shown that South Devon had some of the best and some of the worst dementia care homes. “That galvanised us, but we couldn’t get the funding at the time,” he says. The prime minister’s “dementia challenge” fund came to the rescue with a two year grant worth £255 000.

“One problem is that as soon as you have trained one lot of staff, they’re gone. So we got together with care home owners and tried to identify people who would be around a while. With 180 care homes in South Devon and the attainment standards of staff generally low, you can’t hope to do it all at once. We focused on 13 homes and used another 10 as controls.”

The project identified dementia “champions” in each home, working with them to improve knowledge, leadership skills, and confidence. Other staff were also trained, though less intensively. The aims were to improve care in the homes and reduce emergency admissions. The first appears to have been achieved, with good feedback from patients and carers; the second will be the subject of longer term analysis, conducted independently by a team at Plymouth University.

Notes

Cite this as:BMJ 2015;350:h1556

Footnotes

The Dementia Team award is sponsored by Dementia UK and the BMJ Awards are sponsored by MDDUS. The awards ceremony takes place on 6 May at the Park Plaza Hotel, Westminster. To find out more go to http://thebmjawards.bmj.com..